Heidi: Welcome to Health Check, I’m Heidi Godman. You know
doctors are always telling us to eat a healthy diet and that sounds fine until
you’re trying to figure out how to make your dinner taste great, too. But, we
have some help for you today. Dr. Michelle Hauser is an internist who also went
to culinary school and she joins us now from Stanford University.

Michelle: Hi, Heidi. How are you?

Heidi: I'm great! I'm glad you're here. I interviewed you
when you were at Harvard University and we did a number of nutrition stories
together when you were at the medical school. Oh wait, it was your residency, right,
when you were at Harvard Medical School?

Michelle: Yes, that's right we first met when I was in
residency.

Heidi: Okay, so you just going to Stanford. Tell us what
you're doing.

Michelle: Okay, so now that I'm done with my internal
medicine residency, and I'm feeling like a real doctor with a license and
whatnot…

Heidi: Yes, congratulations.

Michelle: Thank you. I'm doing a postdoctoral research
fellowship where I am basically studying the effects of healthy lifestyle
change on disease prevention like diabetes and heart disease.

Heidi: Well, that's very interesting. So, what is it that
you are hoping to do with the rest of your career?

Michelle: For the rest of my career, I'm hoping to have a
mix of doing the sort of research that I just mentioned, seeing patients in an
academic medical center where I'm able to teach med students and residents, and
hopefully take what I've learned from research and help change public-policy to
help make it easier to make healthy lifestyle changes.

Heidi: Fantastic, and I know you also have that policy
background. Tell us about that.

Michelle: Oh, so while I was in the middle of med school,
quite a few years ago now, I went to the Harvard Kennedy School of Government
and got a degree which focused on public policy and public administration.

Heidi: Fantastic. You are so well-rounded and you have this
wonderful approach -also made even more wonderful because you went to culinary
school. In fact, you went there long before you went to medical school, right?

Michelle: Yes, definitely.

Heidi: Tell us about that. Why did you go to culinary school?

Michelle: That was about 15 years ago, now. Oh my gosh. And,
I went there because I - it's a longer story than we have time for today, but
the gist of it is that I grew up in a pretty poor family and no one had a lot
of faith that I would really end up being a doctor. I was trying to find my
second passion to focus on so I ended up going to culinary school because I
thought that would be what I would do with my life. Now, I guess I'm still
doing something with it. But, I decided I would try out the medicine and that’s
working out okay.

Heidi: Yeah, I think you've done very, very well. Congratulations
on all of your success so far. So this nutrition approach, I know gives you a really
great perspective on treating all kinds of diseases - especially heart disease
which is what you're focusing on now. Tell us about that perspective.

Michelle: So, that perspective really stems initially from
some personal changes that I made. That is, when I was growing up I had some
extra weight and was doing all the unhealthy things that we talk about. I was
drinking a lot of soda, eating a lot of fried and fast foods. When I made the
changes in my life, when I learned what they were and figured out ways to do
them, I just feel like a totally new person. So, while I was in my premed
classes, I was also teaching at a culinary school. At that time, I started
researching nutrition on my own. My students at the culinary school would ask a
lot of questions about what they could do to make something healthier.After awhile, their family members started
telling me stories about how they didn't have to be on a blood pressure
medicine or that they were off insulin - or they cut down their insulin - for
their diabetes, or were off anti-depressants. I think I was really hooked for
the long term at that point on. When I really realized I could make a big
difference if I focus on healthy lifestyle changes.

Heidi: Incredible. Well, what about the mistakes that people
have been making that you've noticed. Have you been able to help them change
their diet, change what they’re eating? But what is it that they were doing
that wasn't right?

Michelle: There are quite a few things, and I mean we really
pay people a disservice by focusing on people not having enough "willpower.”
But, it's really over the years as we've grown more obese and overweight as a
nation that the food environment has really changed. The things that are
easiest to eat and easiest to make are the things that tend to be the least
healthy for us. They also tend to be less expensive because of the way we
subsidize our food in this country. So, you know, things like sugar sweetened
beverages – which are sodas and juices - fast food, fried food and basically
anything that's really far away from how it started out when it grew from the
ground. Things like cookies and things that come in boxes and packages in the
store.

Heidi: Things that are very processed.

Michelle: Very processed, yes.

Heidi: Well, I do want to talk about some of the consequences
of eating this food because we know, generally speaking, it's bad for us. But,
let's get down to the nitty-gritty. So, you mentioned sugar sweetened beverages.
The statistics on how much added sugar people are eating everyday are very
disturbing. So, let's talk about sugar and what it can do to our bodies. Why is
too much sugar not a good thing?

Michelle: So, the biggest risk of too much sugar - and I
think you made a good point that the sugar were talking about is added sugar. So,
I'm not telling anyone they should be cutting out fruit or sugars that are
naturally occurring. That's a separate issue. Added sugars, we don't actually
need any to survive and they do present an increased risk of diabetes and
weight gain. And the weight gain plays into the risk of diabetes and also into
heart disease and other risk factors that go along with that like high blood
pressure.

Heidi: What is it about sugar when it gets into the
bloodstream? I know it's making high blood sugar, and what else is it doing physiologically
to us?

Michelle: So, when we eat added sugars what happens is that
an organ, kind of right where you would point to your “stomach” if you said, “oh,
you know, I'm really hungry,” is an organ called the pancreas which makes our
natural insulin. When we have a bunch of sugar, it will spit out a bunch of
insulin - usually more than you would really need to digest and use that sugar.
What happens then is that after your blood sugar goes up really high, that
extra insulin makes it go down really low, really fast. What that does is it
makes you hungry right away, as soon as your blood sugar gets low, even though
you didn't do enough work for burn off enough calories to take care of whatever
it was you just ate. It's a vicious cycle.

Heidi: Sure.

Michelle: You don't have enough willpower to fight that.
It’s a thing that’s been there as long as we've been humans. We can't really
fight it.

Heidi: And sugar is also linked to inflammation and diabetes
and heart disease and there was a big study that just talked about the link
between added sugar and heart disease. So yeah, added sugar - you definitely
want to avoid that. What about the consequences of fat? Fat, I think, it's a
very confusing topic. Some fat, the unsaturated fats, are good for us in a limited
amount. Of the saturated fat, the trans fat, what are the problems with those?

Michelle: Right. As you said, fats are a complicated thing.
There are a lot of experts who are very well respected who will say low-fat
diets, or higher fat - as long as they are good fats - are fine. So where
everyone agrees, I think, is that we should be cutting out trans fat as much as
possible. The government says that we should get less than 1 g per day. But,
really, if you get none, that would be best. That's because trans fats cause
our bad cholesterol to go up and our good cholesterol to go down. It has the worst
effect of any type of fat on our cholesterol. That means, I think that one of
the statistics was, 200,000 heart attacks and deaths could be avoided, at the peak
of our trans fat consumption, if we cut trans fat out of our diets. It
reallyleads to a lot of cholesterol
problems. Where you get trans fat in your diet is mainly hydrogenated vegetable
oils. There's a little bit naturally-occurring in beef and red meat and dairy
fats. But I think the jury is out for little bit on whether or not those are
quite as bad as the ones that are artificially made with the vegetable oils.

Heidi: Right, right, and what about the saturated fat? Because,
because you're mentioning beef and things like that which, of course, are full
of saturated fat.

Michelle: So, saturated fat. So, we know saturated fat, it's
found in things like meat and dairy products, like butter and cheese, and fast
foods and desserts, that puts us at increased risk of things like heart disease,
bad cholesterol going up, and what not. But, it's not as bad for you as trans
fat, and, I think, the studies really give a complicated picture. The way that I
read through them is that it's good to cut out saturated fat - if you replace
it with how the fat with fruits and vegetables. But, if you just replace the
saturated fat with things like added sugars and a lot of processed food, it
actually makes you less healthy. So, you really have to be careful when you cut
out saturated fat, what you're putting your diet to replace it.

Heidi: Excellent point. And I think a lot of people don't
think about that. They just think, “oh, I'm getting rid of this one thing and
now I can fill it with all this other stuff.” So, very good to bring that up. Then
we should also mention salt, sodium. So many foods have it - restaurant food
and so many different things – but salt is also a risk for high blood pressure
and our heart. Tell us about that.

Michelle: The thing is with salt is that we eat about 1 1/2
to 2 times twice as much as we should per day. And, that is, when we say how
much we should eat, it's actually a maximum of what we should eat. So, we
actually need a very, very tiny portion of what we take in to actually survive,
because we need a little. I don't think there's anyone out there that has to be
concerned about getting enough salt - unless you're a marathon runner or some
sort of really elite athlete. The main problem with salt is that it raises
blood pressure, and for some people it raises blood pressure a lot and for some
people it doesn't have quite as much of an affect. The tricky part is just that
testing it out on yourself you don't really know whether or not you're one of
those people that it affects a lot or little. So, anyone that has high blood
pressure would really benefit from trying to cut out - even if it's for a short
time, as much as they can and really get the level down low to see if their
blood pressure improves. If it doesn't improve that much, they should still stick
to the recommended amount, but, you know, maybe they need to look elsewhere,
like weight loss and exercise and what not to get at lifestyle factors that
affect their blood pressure.

Heidi: Yes and weight-loss and weight control, at least, we
should say has a huge impact on good health. Tell us about that.

Michelle: Yes, weight control is one the most important
things we can do, because a lot of the risk factors that we talked about before
really are tied to, and you can't separate them from, weight control. Because a
lot of bad habits and things that we do to ourselves travel together. Many of
them lead to increased weight, so if you're gaining weight, or you're quite
overweight or obese, then you're a much higher risk of not only heart disease
and stroke, but diabetes, cancer, worsening arthritis for sure, infertility - which
a lot of people don't think about - and a lot of problems with sleep, like
sleep apnea. Then, when you don't get enough sleep, or enough good sleep, it
actually makes you hungrier and you eat more and that's also a vicious cycle. So,
it's very important.

Heidi: Alright, well these are all excellent points, and now
we want to find out what to do about it, but we need to take a quick break. So,
everybody don't go away. More with Dr. Michelle Hauser from Stanford in just a
minute. You're listening to Health Check with
Heidi Godman on WSRQ.